Ageing and sexuality

Several studies have shown that men with lower urinary tract symptoms are more likely to experience erectile dysfunction. All except 1 of these studies were cross-sectional, limiting inferences about whether lower urinary tract symptoms precipitate erectile dysfunction. The association between lower urinary tract symptoms and incident erectile dysfunction was examined prospectively in the Health Professionals Follow-Up Study. Lower urinary tract symptoms were assessed biennially by the American Urological Association symptom index, which captures symptoms of frequency, urgency and force of urinary stream. Severe lower urinary tract symptoms was defined as a symptom score of 20 points or greater and no lower urinary tract symptoms was defined as a score of 7 points or less in men not treated for lower urinary tract symptoms. In 2000 the men were asked to rate erectile function for several periods. Erectile dysfunction was defined as poor or very poor function, or erectile dysfunction medication use, while no erectile dysfunction was defined as very good or good function and no erectile dysfunction medication use. We estimated the RR using Poisson regression, adjusting for age and other potentially confounding factors. We observed 3,953 incident erectile dysfunction cases among 17,086 men. Men with severe lower urinary tract symptoms in 1994 or earlier had a statistically significant 40% higher risk of erectile dysfunction subsequently than men without lower urinary tract symptoms. The risk of erectile dysfunction increased with increasing lower urinary tract symptom severity (p trend <0.0001). The positive association between lower urinary tract symptoms and erectile dysfunction was stronger in younger than in older men (p interaction = 0.03). This study provides evidence that men with lower urinary tract symptoms are more likely to have erectile dysfunction subsequently.

Systemic inflammation is believed to contribute to declining muscle health during aging. The present study aims to examine associations between indicators of muscle health and pro- and anti-inflammatory biomarkers in older men and women, while also considering the impacts of physical activity and protein intake. An assessment of skeletal muscle index (SMI) by bioelectrical impedance analysis, handgrip strength, and 5-sit-to-stand time, using standardized procedures, was conducted in a population of older men (n = 90) and women (n = 148) aged 65–70 years. The inflammatory biomarkers C-reactive protein (CRP), fibrinogen, interleukin (IL)-6, IL-10, IL-18, tumor necrosis factor (TNF)-α, monocyte chemoattractant protein-1, and macrophage inflammatory protein-1α were assessed in blood samples. Data were analyzed and stratified according to biological sex using multiple linear regression models. In older women, SMI was inversely associated with the pro-inflammatory markers CRP (β = −0.372; p < 0.05), fibrinogen (β = −0.376; p < 0.05), and IL-6 (β = −0.369; p < 0.05). Importantly, these associations were independent of abdominal adiposity (waist circumference), protein intake, physical activity level, as well as any adherence to muscle strengthening guidelines (≥2 sessions/week). In contrast, no corresponding associations were observed in men. In conclusion, our findings indicate the detrimental influence of a pro-inflammatory environment on muscle health regardless of important lifestyle-related factors in older women. However, the lack of such associations in older men highlights the importance of considering biological sex when examining the complex interaction between the systemic inflammatory environment and muscle health.

BackgroundWith a rapidly aging population, physical frailty has become a significant public health concern globally. While the association between frailty, depression, and cognitive decline has been widely studied in developed countries, there is limited evidence from low- and middle-income countries, including India. Additionally, little is known about the sex-specific associations between frailty, and mental and cognitive health outcomes. We examined the associations of physical frailty with depressive symptoms and cognitive functioning among older Indian men and women, while also exploring how the frailty-cognition link differs between those with and without depression.MethodsWe used data from the Longitudinal Aging Study in India, conducted between 2017 and 2019. The analytic sample consisted of 14,652 males and 15,899 females aged ≥ 60 years. Frailty was assessed using a modified version of Fried’s frailty phenotype, depressive symptoms were evaluated using the Composite International Diagnostic Interview- Short Form, and cognitive ability was measured through memory, orientation, arithmetic, executive function, and object naming tasks. Univariate and multivariable linear regression models were used to examine the associations between frailty, depressive symptoms, and cognitive ability in older men and women, as well as frailty-cognition association by depressive status.ResultsThe prevalence of frailty was higher in older women than that in older men (32.2% vs. 27.4%). The mean depressive symptom score was higher (0.8 vs 1.0), and the mean cognitive score was lower (26.4 vs 22.1) among older women than men. Physical frailty was associated with higher levels of depressive symptoms (β = 0.51; 95% CI: 0.39, 0.64), and poor cognitive performance (β = -1.06; 95% CI: -1.37, -0.75). Non-frail older men had lower depressive symptoms than frail older men (β = -0.48; 95% CI: -0.66, -0.31), however, the association was not significant among older women. Furthermore, frail older women performed worse on cognitive tests than did frail older men (β = -2.14; 95% CI: -2.40, -1.87). In addition, non-frail older women had poorer cognitive performance than frail older men (β = -0.77; 95% CI: -1.22, -0.32). Conversely, stratification by depressive status showed that frailty was associated with worse cognitive ability, with no difference between individuals with and without depression.ConclusionsWe found that frail older individuals, particularly women, have significant mental and cognitive deficits compared with their non-frail counterparts. Our findings have major implications in both community and clinical settings. Appropriate policies and programs should be implemented to reinforce the strength of pre-frail and frail older adults and maintain improved mental health and cognition in older adults.

The clinical significance of osteoporosis lies in the occurrence of fragility fractures (FFx), and the most relevant fracture site is the hip. The T-score is defined as follows: (BMDpatient–BMDyoung adult mean)/SDyoung adult population, where BMD is bone mineral density and SD is the standard deviation. When the femoral neck (FN) is measured in adult Caucasian women, a cutpoint value of patient BMD of 2.5 SD below the young adult mean BMD results in a prevalence the same as the lifetime risk of hip FFx for Caucasian women. The FN T-score criterion for classifying osteoporosis in older Caucasian men has been provisionally recommended to be − 2.5, but debates remain. Based on a systematic literature review, we noted that older men suffer from hip FFx at a FN T-score approximately 0.5–0.6 higher than older women. While the mean hip FFx FN T-score of around − 2.9 for women lies below − 2.5, the mean hip FF FN T-score of around − 2.33 for men lies above − 2.5. This is likely associated with that older male populations have a higher mean T-score than older female populations. We propose a new category of low BMD status, osteofrailia, for older Caucasian men with T-score ≤ − 2 (T-score ≤ − 2.1 for older Chinese men) who are likely to suffer from hip FFx. The group with T-score ≤ − 2 for older Caucasian men is comparable in prevalence to the group with T-score ≤ − 2.5 for older Caucasian women. However, older men in such category on average have only half the FFx risk as that of older women with osteoporotic T-score.

Background: Reduced fat metabolism (FM) in older persons may be caused by reduced physical activity and peak oxygen consumption (VO2peak). This study aimed to estimate total body FM in older men and women, and evaluate the extent to which reversing inactivity with an exercise program would improve FM. Methods: VO2peak and FM (inferred from respiratory exchange ratio; RER) in older subjects were compared before and after a progressive 8-week intermittent aerobic exercise program. All participants (42 older women aged 74 ± 3 y and 41 men aged 74 ±3 y) completed a peak voluntary graded exercise test on a cycle ergometer, and VO2 and RER were measured. Twenty-two older women and 22 men completed 8 weeks of exercise training (3 × 1 h weekly sessions on a cycle ergometer). Exercise intensity progressed from 40% of the maximal pretest workload to 100% by the end of the program. The remaining subjects served as controls. Results: RER was significantly higher in women (RER= 0.49 VO2+0.60) than men (RER=0.27 VO2+0.71; P= 0.001). Exercise training increased VO2peak (20% for women, 30% for men) and decreased RER at submaximal VO2 in men (RER= 0.21 VO2+0.75 vs. RER= 0.27 VO2+0.71), but not women (RER= 0.49 VO2+0.60). Conclusion: Although the literature reports that FM is reduced in older men and women, this study demonstrated that, in men, FM was increased after aerobic training, but not in women, despite an increased VO2peak in both.

In this study, we focused on muscle sympathetic nerve activity (MSNA) burst size and occurrence separately as subcomponents of the sympathetic baroreflex in older adults, and we found that the distribution (variation) of burst size against burst occurrence was greater in women than men. Older women had greater carotid artery stiffness compared with older men, while blood pressure (BP) distribution (variation) was comparable between sexes. Sympathetic baroreflex sensitivity assessed with burst incidence was less sensitive as the carotid artery became stiffer in older men and women, while that assessed with burst area was more sensitive as the carotid artery became stiffer in older women but not in older men. These results help us understand the mechanisms underlying the compensation for the impaired response of MSNA burst occurrence in older women with greater carotid artery stiffness to regulate BP similar to that in older men. There are sex differences in arterial stiffness and neural control of blood pressure (BP) among older adults. We examined whether the sympathetic response to BP is greater in older women than men in burst size but not burst occurrence. Burst occurrence and size were assessed with burst interval and area of muscle sympathetic nerve activity, respectively, and the distributions of these indices were evaluated by range during supine rest in 61 healthy older subjects (30 men (69±6years) and 31 women (68±6years); means±SD). Also, we analysed sympathetic baroreflex sensitivity (BRS) with burst occurrence and area simultaneously. Carotid β-stiffness was measured with B-mode ultrasonic image and carotid BP. The range of burst interval was smaller in older women than men (P=0.002), while there was no difference in the range of burst area. Carotid β-stiffness was greater in older women than men (6.7±2.7 vs. 5.1±2.7, P=0.027). Sympathetic BRS assessed with burst incidence was lower in older women than men (-2.3±1.4 vs. -3.3±1.4 bursts·100beats-1 mmHg-1 , P=0.007), while this sex difference was observed when assessed with burst area after adjusting for carotid β-stiffness (-116.1±135.0 vs. -185.9±148.2a.u. burst-1 mmHg-1 , P=0.040), but not before. Sympathetic BRS assessed with burst area was negatively (more sensitive) correlated with carotid β-stiffness in older women (r=-0.53, P=0.002) but not men. These data suggest that the response of burst size within each burst is augmented for the baroreflex BP control despite the impaired response of burst occurrence in older women with greater carotid stiffness.

Elevated homocysteine is associated with poorer self-perceived physical health in older men: The Health in Men Study

Risk factors for new atherothrombotic brain infarction in 664 older men and 1,488 older women

Management of Antipsychotic-Related Sexual Dysfunction: Systematic Review

Effects of urge urinary incontinence on quality of life in older people.

Impairments of sexual functioning, the dysfunctions, are classified in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) in seven categories. Sexual Desire Disorders include Hypoactive Sexual Desire involving deficient (or absent) sexual fantasies and desire for sexual activity, and Sexual Aversion, involving extreme aversion to and avoidance of all or almost all genital sexual contact with a partner. Sexual Arousal Disorders include Female Sexual Arousal Disorder, an inability to attain or maintain an adequate genital lubrication-swelling response of sexual excitement until completion of the sexual activity, and Male Erectile Disorder, an inability to attain or maintain an adequate erection until completion of the sexual activity. Orgasm Disorders include Female and Male Orgasmic Disorders and Premature Ejaculation. Female Orgasmic Disorder is delay or absence of orgasm following a normal sexual-excitement phase. It is pointed out that women vary widely in the type or intensity of stimulation that triggers orgasm and that the diagnosis should be based on the clinician’s judgment that the woman’s orgasmic capacity is less than would be reasonable for her age, sexual experience, and the adequacy of sexual stimulation she receives. Presumably, such absence of orgasmic capacity would not be accepted as a disorder in such women as those who reported in many surveys that they enjoyed intercourse very much, although they did not reach orgasm (McConaghy, 1993), provided it did not cause marked distress or interpersonal difficulty (Criterion B).

Age-disparate sexual relationships are couched in unequal gender power dynamics, with grave social and health consequences. Older men dominate young women in sexual relationships owing to a masculine tendency. However, there is limited information on a new vista of age-disparate sexual relationships involving older women and young men. In this regard, this study explored gender and social inequalities in sexual relationships, which are largely undocumented. This study employed a qualitative research methodology to explore age-disparate sexual relationships between older men and young females, on the one hand, and young males and older women, on the other hand. Thirty (30) in-depth interviews (IDIs), six (6) focus group discussions (FGDs), and eighteen (18) key informant interviews (KIIs) were conducted across the three main ethnic groups in Nigeria. The findings showed that older men dominated young women in sexual relationships through suppression, which undermined their ability to negotiate safer sex, diminished their individual agency, and led to multiple sexual partnerships. On the other hand, participants reported that older women lured young men into sexual relationships because of financial vulnerability, sexual urges, and young men's intentions to build contacts with the cream of society. Older men and women also preyed on their unsuspecting young victims for fetish reasons, such as ritual money and metaphysical atonement. This study showed that disadvantaged socio-economic status makes older men and women exploit and take advantage of young, unmarried women and men in sexual relationships. Wide age difference and the notion of fulfilling their side in a paid sexual intercourse make younger females and males unable to negotiate safer sex. These findings speak to gender and social inequalities in sexual relationships, which are largely undocumented in Nigeria. The study concluded that gender-based norms diminished the individual agency of emerging adults, especially females, in achieving positive sexual practices. There is a need for increased awareness of the inimical effects of age-disparate sexual relationships and transactional sex.

Since the initial scientific statement on Secondary Prevention of Coronary Heart Disease (CHD) in the Elderly was published in 2002,1 several trends have continued that make an update highly appropriate. First, the graying of the US population and those of other industrialized countries has progressed unabated because more adults are surviving into their senior years. The number of Americans aged ≥75 years was estimated at 18.6 million in 2010, representing ≈6% of the population,2 and it is expected to double by 2050. The population aged ≥85 years is growing the most rapidly, with numbers expected to reach 19.5 million by 2040. In 2008, 67% of the 811 940 cardiovascular deaths in the United States occurred in people aged ≥75 years.3 In parallel to this increase in the older adult demographic, the number of Americans with CHD has increased to an estimated 16.3 million, more than half of whom are >65 years of age.3 Similarly, 7 million have had a stroke, the incidence of which approximately doubles with successive age decades after 45 to 54 years.3 Peripheral artery disease (PAD) affects 8 to 10 million Americans, the majority of whom are >65 years of age. Between 2015 and 2030, annual US costs related to atherosclerotic cardiovascular disease (ASCVD) are projected to increase from $84.8 billion to $202 billion.3 Moreover, given that ASCVD often undermines functional capacity and independence and increases reliance on long-term care, indirect expenses related to ASCVD are also expected to increase. Thus, the need for effective secondary prevention measures in the older adult population with known ASCVD has never been greater. Notably, the 2011 American Heart Association (AHA)/American College of Cardiology Foundation (ACCF) updated guidelines for secondary prevention of CHD broadened …

Reviewed here are the major nutritional problems of older females, stressing where older female nutrition differs from that of older males. Older females have a higher body mass index and lower waist-to-hip ratio than do older males. Older females reduce their food intake compared to younger females much less than do older males compared to younger males. Total energy expenditure is minimally reduced in older females compared to young females. Resting metabolic rate is reduced by 13% in older females. The major nutritional problem faced by older females, protein energy malnutrition, and its reversible causes are addressed. Inability to recognize the need for fluids is a common problem leading to dehydration in older persons. Older persons are at major risk for ingesting less than two-thirds of the recommended dietary allowance for vitamins. Older women are more likely than men to take vitamin or mineral supplements. Osteopenia is a common problem leading to fractures in older women, and decreased calcium intake and vitamin D deficiency, as well as estrogen deficiency, play a role in the pathogenesis of osteopenia. Total cholesterol levels increase with age in older women, while high-density lipoprotein cholesterol levels decline. However, cholesterol levels that are optimum for survival are higher in older women than in older men. At < 65 years of age, diabetes mellitus (DM) is more common in females, and at > 65 years of age it is more common in males. Over one-half of older persons with DM are undiagnosed. Management of DM in older persons requires a judicious approach to balance the potential problems of hypo- and hyperglycemia.

We estimate how much caregiving men and women respectively do, and how much of the caregiving is done by older (65+) and younger persons, inside their household and for other households, in Spain and in Sweden. To assess this, we use self-reported hours of caregiving from two national surveys about caregiving, performed in 2014 (Spain, N = 2003; Sweden, N = 1193). Spain and Sweden have dissimilar household structures, and different social services for older (65+) persons. Caregivers, on average, provide many more hours of care in Spain than in Sweden. Women provide about 58% of all hours of caregiving, in Spain in all age groups, in Sweden only among younger caregivers. The reason is the dominance of partner caregivers among older Swedes, with older men and women providing equal hours of care. Family caregiving inside the household is more extensive in the more complex Spanish households than in Swedish households. Family care between households prevails in Sweden, where the large majority of older persons live with a partner only, or alone. This is increasingly common in Spain, although it remains at a lower level. We estimate that older persons provide between 22% and 33% of all hours of caregiving in Spain, and between 41% and 49% in Sweden. Patterns of caregiving appear to be determined mainly by demography and household structure.